Report 2014-130 Recommendation 11 Responses

Report 2014-130: California Department of Health Care Services: It Should Improve Its Administration and Oversight of School‑Based Medi-Cal Programs (Release Date: August 2015)

Recommendation #11 To: Health Care Services, Department of

To streamline the organizational structure of its administrative activities program and to improve the program's cost-effectiveness, Heath Care Services should implement a single statewide quarterly random moment time survey and develop and issue a request for proposals to identify a responsible vendor to assist in implementing a statewide quarterly random moment time survey.

Annual Follow-Up Agency Response From October 2021

CMS approved SPA 15-021 on April 27, 2020, with an implementation date of July 1, 2020. Once the new integrated RMTS process has been implemented for eight quarters, DHCS will review all available RMTS data and determine if a statewide quarterly RMTS option is feasible. Since SPA 15-021 was implemented on July 1, 2020, DHCS will need at least two years (through FY 2022-23) of data to determine the feasibility for statewide RMTS, and an additional two years (through FY 2024-25) to implement statewide RMTS.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Annual Follow-Up Agency Response From November 2020

The Centers for Medicare and Medicaid Services (CMS) approved SPA 15-021 on April 27, 2020, with an implementation date of July 1, 2020. Once the new integrated RMTS process has been implemented for eight quarters, DHCS will review all available RMTS data and determine if a statewide quarterly RMTS option is feasible. Since SPA 15-021 was implemented on July 1, 2020, DHCS will need at least two years (through FY 2022-23) of data to determine the feasibility for statewide RMTS, and an additional two years (through FY 2024-25) to implement statewide RMTS.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Annual Follow-Up Agency Response From October 2019

Back-casting completed in June 30, 2019, and SPA 15-021 is anticipated to be implemented July 1, 2020. Once the new integrated RMTS process has been implemented for eight quarters, DHCS will review all available RMTS data and determine if a statewide quarterly RMTS option is feasible. If SPA 15-021 is implemented beginning July 1, 2020, then DHCS will need at least two years (through FY 2022-23) of data to determine the feasibility for statewide RMTS, and an additional two years (through FY 2024-25) to implement statewide RMTS.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Annual Follow-Up Agency Response From August 2019

Back-casting completed in June 30, 2019, and SPA 15 021 is anticipated to be implemented July 1, 2020. Once the new integrated RMTS process has been implemented for eight quarters, DHCS will review all available RMTS data and determine if a statewide quarterly RMTS option is feasible. If SPA 15-021 is implemented beginning July 1, 2020, then DHCS will need at least two years of data to determine the feasibility for statewide RMTS, and an additional two years to implement statewide RMTS.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Annual Follow-Up Agency Response From November 2018

Back-casting will be completed June 30, 2019, and SPA 15-021 does not have an implementation date to onboard LEA Medi-Cal Billing Option Program (BOP) to RMTS. At that time, DHCS will review all available RMTS data and determine if a statewide quarterly RMTS option is feasible. If SPA 15-021 is implemented beginning July 1, 2019, then DHCS will need at least two years of data to determine the feasibility for statewide RMTS, and an additional two years to implement statewide RMTS, therefore, estimated statewide RMTS implementation is July 1, 2024.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Annual Follow-Up Agency Response From September 2017

An RFP to implement a statewide RMTS continues to be premature. The current structure was established in collaboration with stakeholders, and at their request. Since invoices have only been submitted for the first two quarters of RMTS, DHCS does not have sufficient data to determine if moving to a statewide structure would be more efficient, given that the current structure is capturing all activities of the participants.

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement

1-Year Agency Response

DHCS has determined it would not implement a statewide RMTS and therefore will not develop and issue a request for proposal. DHCS currently has an RMTS system in place that was established in collaboration with stakeholders. DHCS may continue to review the option of issuing a request for proposal for a statewide quarterly random moment survey in the future, however DHCS will not implement at this time.

California State Auditor's Assessment of 1-Year Status: Will Not Implement

We continue to believe that implementing a single statewide quarterly time survey would result in significant savings for claiming units and would simplify the oversight of the administrative activities program. As we mention on page 42 of our audit report, by conducting nine separate time surveys each quarter rather than a single statewide quarterly time survey, participants in the administrative activities program expend nine times the effort and incur corresponding additional costs to complete, code, and assure the quality of the time survey responses.

6-Month Agency Response

DHCS disagrees with this recommendation.

DHCS continues to contact other states to determine the number and type of resources necessary to administer Random Moment Time Survey (RMTS) at a statewide level. DHCS has received responses from Texas and Indiana to its initial inquiries and continues to seek input from additional states. Because of the depth and scope of this research, no conclusions about the practicality of a statewide RMTS system can be determined at this time.

California State Auditor's Assessment of 6-Month Status: Pending

We believe that when Health Care Services completes its analysis, it will agree that implementing a single statewide quarterly time survey will result in significant savings for claiming units and will simplify the oversight of the administrative activities program.

60-Day Agency Response

At this time, DHCS will not implement this recommendation. However, DHCS has begun to reach out to other states that administer a statewide Random Moment Time Study (RMTS) methodology in order to identify a set of best practices for the development and implementation of a statewide RMTS in California, and determine the number and type of resources necessary to administer the program at a statewide level. This research is in the very early stages and does not support any conclusions. Once that review is complete, DHCS will make a determination of the practicality of a statewide RMTS implementation.

California State Auditor's Assessment of 60-Day Status: Pending

We believe that when Health Care Services completes its analysis, it will agree that implementing a single statewide quarterly time survey will result in significant savings for claiming units and will simplify the oversight of the administrative activities program.

All Recommendations in 2014-130

Agency responses received are posted verbatim.